The purpose of this study is to determine the difference in the impact of moderate positive
end-expiratory pressure (PEEP) on hepatic venous flow Doppler in patients undergoing cardiac
surgery: conventional versus protective ventilation strategy The possible changes in forward
and backward flows (Doppler profiles) of hepatic venous flow at different degrees of PEEP in
conventional and protective ventilation strategies are analyzed by using intraoperative
transesophageal echocar...

Spontaneous breathing efforts in patients with respiratory failure connected to mechanical
ventilation, has been associated with strong respiratory muscles activity. However, these
mechanisms may will be present in patients with acute lung deseases who are breathing with no
ventilatory support.
We hypothesize that spontaneous breathing during acute respiratory failure could induced lung
inflammation and worsen lung damage. Hereby, the connection to a ventilatory support tool,
...

This Randomized controlled clinical study, entitled "Effects on Respiratory mechanics of two
different ventilation strategies during Robotic- Gynecological surgery", is an original
paper. The study was performed in Rome, Italy, from September 2014 to September 2015.
Nowadays several studies evaluated the effects of "open lung strategy" and the positive
effect of Recruitment Maneuvers and Positive End Expiratory Pressure (PEEP) application
during general anesthesia, especially ...

Mechanical ventilation with low tidal volume (about 6 ml.kg-1) reduces mortality in ALI/ARDS
patients respect to high tidal volume ventilation (about 12 ml.kg-1).
This finding is usually explained by alveolar tidal overdistension associated to high tidal
volume. Stretch-induced lung injury may trigger a cytokine-mediated inflammatory response.
This may contribute to the development of systemic inflammatory response and multiple system
organ failure and death.
High tidal...

Unresolved ARDS is defined by the persistence of ARDS criteria at the end of the first week
of evolution despite an appropriate treatment of the cause of ARDS. A persistent ARDS is
associated with an increased mortality and prolonged lengths of mechanical ventilation, ICU
stay and hospitalization. Persistent ARDS is characterized by ongoing inflammation,
parenchymal-cell proliferation, and fibroproliferation leading to disordered deposition of
collagen. All of these pathways ma...

Recruitment manoeuvres, consisting of sustained inflations at high airway pressures, have
been advocated as an adjunct to mechanical ventilation in lung protective ventilation
strategies to prevent the collapse of the lung.
This study aims to determine the safety and efficacy of a recruitment manoeuvre, by
considering its impact on gas exchange, hemodynamics and on the release of systemic
inflammatory mediators.

Scientific background. Dysregulated systemic inflammation is a key pathogenetic mechanism
for morbidity and mortality in ALI/ARDS, and is associated with tissue insensitivity and/or
resistance to inappropriately elevated endogenous glucocorticoids. In one study, prolonged
methylprednisolone treatment of ARDS patients resulted in rapid and sustained reduction in
circulating and pulmonary levels of pro-inflammatory cytokines, chemokines, and procollagen.
Preliminary work. Five r...

Patients who experience lung injury are often placed on a ventilator to help them heal;
however, if the ventilator volume settings are too high, it can cause additional lung injury.
It is proven that using lower ventilator volume settings improves outcomes. In patients with
acute brain injury, it is proven that maintaining a normal partial pressure of carbon dioxide
in the arterial blood improves outcomes. Mechanical ventilator settings with higher volumes
and higher breathing ...

Background. The use of a comprehensive strategy providing low tidal volumes, peep and
recruiting maneuvers in patients undergoing open abdominal surgery improves postoperative
respiratory function and clinical outcome. It is unknown whether such ventilatory approach
may be feasible and/or beneficial in patients undergoing laparoscopy, as pneumoperitoneum
and Trendelenburg position may alter lung volumes and chest-wall elastance.
Objective. The investigators designed a randomiz...

Spontaneous breathing during mechanical ventilation has been recommended in patients with
ARDS and is currently used. in part because oxygenation is better and there is a lower risk
of diaphragm dysfunction due to disuse. The other approach to minimizing lung injury from
spontaneous effort is the use of neuromuscular blockade; an early and short term (48 hours)
of neuromuscular blockade in patients with severe ARDS has been shown to decrease
inflammation and to improve survival...

Compared with the information available in sepsis and trauma-associated ARDS, less is known
about the cause and pattern of lung injury after thoracic surgery. Definition of lung injury
in this context is difficult. Most now use the joint North American-European consensus
conference definitions, but these are based only on gas exchange and radiology criteria.
While gas exchange measures are reliable, thoracotomy inevitably causes radiological change
and the interpretation of pla...

Since strategies were applied in intensive care medicine, including low tidal volume
ventilation, fluid resuscitation, use of antibiotics, restrictive transfusion strategy and
bundle of ventilator therapy, the incidence of Acute Respiratory Distress Syndrome (ARDS)
has been decreased recent years. However, the mortality of severe ARDS is still higher to
45%. Few medications did were indicated to be effective in working on development of ARDS.
Different with other disease, ARDS ...

Few patients who have major risk factors develop Acute Respiratory Distress Syndrome (ARDS).
The heritable determinants might be the reason. The multicenter study is to investigate the
association between ARDS and polymorphism in ARDS gene r.

Protective ventilation (association of a tidal volume < 8 ml/kg with a positive end
expiratory pressure) is poorly used in severe brain-injured patients. Moreover, a systematic
approach to extubation may decrease the rate of extubation failure and enhance outcomes of
brain-injured patients.
We hypothesized that medical education and implementation of an evidence-base care bundle
associating protective ventilation and systemic approach to extubation can reduce the
duratio...

In this study we compared the efficacy of continuous positive airway pressure (CPAP) to
differential lung ventilation, in terms of patient's oxygenation, during video assisted
thoracoscopic lung resection.

The acute respiratory distress syndrome (ARDS) is common condition in critical ill patients
affecting 7.2 people / 100,000 population / year and more than 7% of patients with invasive
mechanical ventilation for more than 24 hours. ARDS carries a high hospital mortality of up
to 48% and consumes large amounts of critical care resources. ARDS patients often present
with severe hypoxemia that is refractory to conventional treatment and are thus evaluated
for extracorporeal membran...

Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by unresolved thromboemboli
in the pulmonary arteries, which lead to pulmonary hypertension and, left untreated, right
heart failure. This disease can be potentially cured by performing a pulmonary
thromboendarterectomy (PTE) to remove the blood clots. The surgery is not without risk and
the most worrisome complication is the development of a form of acute lung injury called
reperfusion lung injury, which occurs in...

Controlled mechanical ventilation may lead to the development of diaphragm muscle atrophy,
which is associated with weakness and adverse clinical outcome. Therefore, it seems
reasonable to switch to partially supported ventilator modes as soon as possible. However, in
patients with high respiratory drive, the application of partially supported modes may result
in high lung distending pressures and diaphragm injury.
Recently, the investigators published a study that demonstrate...

This pilot study tests the feasibility of using a computerized ventilator management
protocol seeking to encourage lung protective ventilation during the acute phase of
ventilation, and esophageal manometry based titration of ventilator settings during the
weaning phase of ventilation, for children with acute respiratory failure. The investigators
hypothesize that such an approach will reduce time on mechanical ventilation, largely by
preserving diaphragm muscle function.